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Wiki 96164 & 96165 in SUD Treatment Coding

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AmyLitterell

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East Wenatchee, WA
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Hello! I have one commercial insurance company that is denying claims using 96164 & 96165 as IOP SUD Group coding. I am coding for an FQHC. This is the only insurance company denying these codes. H0001 & H0004 are being paid. They say it is the incorrect code because it is specifically for Health & Behavior intervention according to the CPT Book. I think it's the correct code because of this. I have spoken with our consultant company that is training our new coders and they agreed it is the correct code to be using, but my appeal is not working with the insurance company. Can anyone help me with this? What am I missing? Thank you for reading this & for your guidance!
 
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